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Re: ketamine infusion reults » johnLA

Posted by SLS on August 8, 2012, at 7:34:19

In reply to ketamine infusion reults, posted by johnLA on August 7, 2012, at 22:38:33

Hi John.

> i finally did my ketamine infusion last week. i'm very sorry to say that i did not get a positive result. possibly one day of placebo relief, if even that.

:-(

> unfortunately as well, those that do not respond to the first infusion most likely will not respond to repeated infusions.
>
> i am very disappointed to say the least.

I am, too. I would have liked to see you get well.

> so, what does a guy do who has tried ect, several ssri's, remeron, effexor and now ketamine, all w/out any positive results?
>
> nardil? tca? some drug combo?

I think you are far from being a hopeless case. You may need to take a combination of three or more medications. Which, if any, of the drugs you tried produced a partial or transient improvement? Which drugs made you feel worse?

Examples of combinations off the top of my head are:

Parnate + nortriptyline + lithium
Effexor + Wellbutrin + Lamictal
Abilify + Wellbutrin + Lamictal
Zoloft + nortriptyline + lithium
Abilify + Effexor + nortriptyline + lithium

* Lithium and Abilify might best be used in low dosages when treating unipolar MDD.

It sometimes makes sense to remain on a drug or drug combination that has produced a partial improvement, and to build a regime around it.

Happily, each person is going to suggest a different set of combination treatments based upon their own experiences with them. The more tools, the better. Recently, Latuda (lurasidone) has been suggested to exert antidepressant effects, perhaps via 5-HT7 receptor antagonism.

For me, the addition of prazosin has helped a great deal. I can get out of bed and even read more easily. I still haven't decided for whom this drug is apt to produce an antidepressant response. However, it is such a benign drug, that it might be worth a try in combination with antidepressants. Prazosin might be particularly useful with noradrenergic drugs, but this is only a guess.

> my depression is deep. i have basically been in bed for over 2 years now. not sure meds are the direction for me at this point. my biggest problems are inertia and ruminating thoughts.

That sounds more like endogenous (melancholic) depression than atypical depression. It depends upon whether or not your problems with inertia is actually an expression of psychomotor retardation. Feeling worse in the morning is another clue indicating endogenous depression. Have you tried imipramine?

> maybe something more behavioral based?

Has this been suggested to you by a mental health professional? Is this a desperate guess made by process of elimination based upon non-response to antidepressant monotherapy?

I say that you should keep moving forward while occasionally looking back. Look back so that you can use the information you have gleaned from your history of responses to previous treatments along with an accounting of the course of your illness and any psychosocial stresses that acted to induce it. Having 20-20 hindsight can be useful.

I get the impression that Paxil is particularly effective as an SSRI. Have you ever tried it? Unfortunately, Paxil has been reported to cause birth defects involving heart and pulmonary valves. If pregnancy isn't an issue, it might make sense to give this drug a try. As with other SSRIs, it can poop-out and lose its effectiveness if discontinued and restarted.

You'll get there.


- Scott


Some see things as they are and ask why.
I dream of things that never were and ask why not.

- George Bernard Shaw

 

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